Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | CNP.09893 | OH |
N | 363LA2200X | Nurse Practitioner - Adult Health | RN190839 | OH |
NPI | 1033240031 |
---|---|
Provider Name | Ms. Leslie Z Vidmar |
First Address | Chesterland, OH 44026-1416 |
Second Address | Cleveland, OH 44128-5757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 11/01/2021 |